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General NPI Number Information
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NPI Number | 1558559435
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Entity Type | Organization
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Legal Business Name | TRINITY SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 918 S MAIN ST
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City | BURLINGTON
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State | NC
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Zip | 27215-5757
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Country | US
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Telephone | 336-513-0411
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Fax | 336-513-0412
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Provider Business Mailing Address
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Address Line | PO BOX 2532
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City | BURLINGTON
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State | NC
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Zip | 27216-2532
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Country | US
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Telephone | 336-513-0411
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Fax | 336-513-0412
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MADIE ANNETTE CLAY
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Credential |
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Telephone | 336-513-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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